Healthcare Provider Details

I. General information

NPI: 1427091347
Provider Name (Legal Business Name): NIOBRARA COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S BALLANCEE AVENUE
LUSK WY
82225
US

IV. Provider business mailing address

PO BOX 780
LUSK WY
82225-0780
US

V. Phone/Fax

Practice location:
  • Phone: 307-334-4000
  • Fax: 307-334-2712
Mailing address:
  • Phone: 307-334-4000
  • Fax: 307-334-0183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number06-203
License Number StateWY

VIII. Authorized Official

Name: MS. NICHOLAS RYAN DOUCETTE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 307-334-4000